digoxin and Heart-Septal-Defects--Ventricular

Topics: Age Factors; Arrhythmias, Cardiac; Child; Child, Preschool; Chlorothiazide; Diet, Sodium-Restricted; Digitalis Glycosides; Digoxin; Diuretics; Ethacrynic Acid; Furosemide; Heart Block; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Organomercury Compounds; Pacemaker, Artificial; Phenytoin; Procainamide; Propranolol; Quinidine; Tetralogy of Fallot; Transposition of Great Vessels

The effect of digoxin on contractility and symptoms in infants with a large ventricular septal defect (VSD) is controversial. Nineteen infants with symptoms of congestive heart failure due to a VSD were studied with load-independent indexes during 4 study periods: (1) before any medication; (2) while on chronic diuretics; (3) while on both diuretics and digoxin; and (4) while on diuretics alone, to determine if digoxin: (a) increases "contractility" when added to diuretic therapy; and (b) improves symptoms. Symptoms, signs (heart and respiratory rates, and weight gain), shortening fraction, preload (left ventricular end-diastolic dimension), afterload (left ventricular end-systolic wall stress) and contractility were measured at each period. The difference between the measured and predicted velocities of circumferential fiber shortening for the measured left ventricular end-systolic wall stress served as an index of contractility. Eighteen infants also underwent catheterization. Mean pulmonary-to-systemic blood flow ratio was 3:1. When digoxin was added to diuretics, contractility index was significantly greater than in control subjects (0.13 +/- 0.15 vs 0.0 +/- 0.12 circ/s, p = 0.04). When patients were again on diuretics alone (after discontinuation of digoxin), contractility index was no longer different. Symptoms and signs were not significantly improved by either diuretics or digoxin. It is concluded that in infants with a large left-to-right VSD shunt and receiving digoxin and diuretics, contractility index was significantly greater than in control subjects. However, neither diuretics alone nor in combination with digoxin improved symptoms significantly.

Topics: Digoxin; Diuretics; Drug Therapy, Combination; Echocardiography; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Myocardial Contraction

A neonate presented on the first day of life with tachypnea and poor feeding. The infant's initial echocardiogram demonstrated outpouching of the lateral wall of the right ventricle (RV) associated with a large ventricular septal defect (VSD). At 9 days of age he was diagnosed with osteogenesis imperfecta (OI). Despite treatment with digoxin, diuretics, and captopril he required hospitalization twice during his first 2 months of life for congestive heart failure (CHF). The VSD was closed at three and one-half months of age without resection of the diverticulum and CHF symptoms resolved. At 26 months of age he is doing well despite the residual RV diverticulum. Congenital cardiac diverticula are rare forms of cardiac malformations and their echo-Doppler features are herein discussed.

Topics: Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Captopril; Cardiac Surgical Procedures; Digoxin; Diuretics; Diverticulum; Echocardiography; Furosemide; Heart Failure; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Infant, Newborn; Male; Myocardial Contraction; Osteogenesis Imperfecta; Stroke Volume

Fetal tachyarrhythmia may cause fetal hydrops and lead to fetal morbidity and mortality. Supraventricular tachycardia and atrial flutter have been the most diagnosed. We present a case of fetal atrial flutter diagnosed during the second trimester treated with digoxin and sotalol and delivered at term.. A 30-year-old primigravid woman was diagnosed with fetal atrial flutter at the gestational age of 25 weeks with atrial rates of 480-520 bpm and ventricular rates of 200-250 bpm. Initially, she was treated with digoxin then with a combination of digoxin and sotalol. The fetal heart beat slowed after sotalol treatment but did not return to sinus rhythm. The fetus was delivered vaginally. Neonatal echocardiography showed a small apical ventricular septal defect and small patent ductus arteriosus. Electrocardiography also revealed atrial flutter with occasional atrial fibrillation.. The efficacy of antiarrhythmic drug therapy for fetal atrial flutter has not been well established. In our case, we used sotalol combined with digoxin and the fetal heart beat slowed after therapy. Sotalol may be considered the drug of choice for fetal atrial flutter. If the fetal atrial flutter is resistant to these therapies, a combination of other congenital cardiac diseases or organic abnormalities should be considered.

Topics: Administration, Oral; Adult; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Delivery, Obstetric; Digoxin; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Ductus Arteriosus, Patent; Echocardiography; Female; Fetal Diseases; Heart Rate, Fetal; Heart Septal Defects, Ventricular; Humans; Infant, Newborn; Pregnancy; Sotalol

Clinical and cardiac catheterization data were collected from 39 infants with coarctation of the aorta and ventricular septal defect, 31 of whom were initially managed only by surgical repair of coarctation. Data were analyzed to determine mortality, morbidity, outcome and factors that might predict survival or the need for septal defect closure. Of the eight patients who did not require surgical treatment before 3 months of age, seven underwent coarctation repair alone at a mean age of 2.3 years. Of the 23 infants managed with coarctation repair alone, before age 3 months, 9 needed no additional surgical treatment and 6 required early and 8 required late repair of the ventricular septal defect. Seven infants underwent coarctation repair and simultaneous pulmonary artery banding and one eventually required debanding after spontaneous closure of the septal defect. The overall mortality rate in this series was 10.3% (mean follow-up time 5.7 years). Of 39 infants, 16 (41%) never required a second operation for ventricular septal defect closure. For patients who had only coarctation or coarctation repair with pulmonary artery banding at less than 3 months of age, ventricular septal defect size was categorized as small (less than 0.5 cm/m2), moderate (less than 1 cm/m2) or large (greater than 1 cm/m2) on the basis of defect size at operative repair or echocardiographic or angiographic assessment. Defect size did not necessarily correlate with the need for operative repair.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aortic Coarctation; Constriction; Digoxin; Female; Follow-Up Studies; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Male; Prognosis; Pulmonary Artery; Survival Rate; Treatment Outcome

A 2 months old girl was given a tenfold increased dosage of Beta-Methyldigoxin for 2 weeks and subsequently developed severe symptoms of glycoside intoxication. In hospital she was treated by digoxin-specific Fab antibody fragments. 18 hours later the symptoms had totally disappeared. However, 48 hours from the beginning of the treatment free digoxin levels rose again to toxic ranges. In chronic intoxications the rediffusion of glycosides from tissues and interstitial space seems to be much more pronounced than in acute intoxications, and there is a higher risk of reintoxication.

Topics: Chronic Disease; Digoxin; Dose-Response Relationship, Drug; Female; Heart Septal Defects, Ventricular; Humans; Immunoglobulin Fab Fragments; Infant; Medigoxin

Topics: Digoxin; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Myocardial Contraction

Inotropic support with digoxin is commonly used in patients with left ventricular volume overload due to ventricular septal defect (VSD). However, the hemodynamic consequences of inotropic agents with VSD have not been experimentally explored. We studied two inotropic agents, digoxin and amrinone, in chronically instrumented lambs with left ventricular volume overload due to a surgically created VSD. Intravenous digoxin (40 micrograms/kg) produced serum levels of 3.5 +/- 0.9 ng/ml (mean +/- SD) in seven lambs 60 min after administration, reduced the heart rate by 16% (172 to 149 beats/min, p less than 0.05), increased the stroke volume 16% (29.8 to 34.5 ml/beat, p less than 0.05) but did not significantly alter the systemic flow index (Qs), the pulmonary flow index (Qp), or the volume of left to right shunt (QL-R, 6.74 to 6.77 liter/min/m2). The mean left atrial pressure (LA) was unchanged (17.6 versus 17.1 mm Hg) following digoxin. Chronic digoxin use in four lambs for 4 days (25 +/- 8 micrograms/kg/8 h) produced trough serum levels of 1.2 +/- 0.2 ng/ml. There was no additional hemodynamic effect compared to acute digoxin, the Qp/Qs ratio was unchanged (3.10 versus 3.08) and evidence of left ventricular volume overload (LA - 14.0 versus 13.4) was unchanged. Amrinone lowered the systemic resistance index in a dose dependent fashion. The peak reduction of 20% (25.3 to 20.3 U/m2, p less than 0.01) occurred at 20 min after an intravenous (3 mg/kg) bolus in seven lambs. The Qs increased from 2.58 to 3.10 liter/min/m2 (p less than 0.01). The Qp was unchanged, thus the Qp/Qs ratio was lowered by 16% (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aminopyridines; Amrinone; Animals; Animals, Newborn; Digoxin; Dose-Response Relationship, Drug; Heart Septal Defects, Ventricular; Hemodynamics; Myocardial Contraction; Sheep; Time Factors

Digoxin alone was used to treat a congested circulatory state in 21 infants (mean age, 2.7 months; mean weight, 3.8 kg) with a ventricular septal defect. The dose was adjusted on the basis of pharmacokinetics to achieve a mean steady-state concentration of 1.6 +/- 0.3 ng of digoxin per milliliter of serum. The mean red-cell level of sodium-potassium ATPase fell from 23.1 +/- 7.0 to 12.6 +/- 5.2 nmol per milligram per minute with treatment. Only 6 of the 21 patients had an inotropic response, as reflected by echocardiographic measurements, but the drug was of clinical benefit to 12 infants (including these 6). These results show that not all infants with a congested circulatory state due to a ventricular septal defect benefit from digoxin therapy. Furthermore, in some subjects clinical improvement occurs in the absence of a measurable inotropic response.

Topics: Digoxin; Drug Evaluation; Echocardiography; Heart Failure; Heart Septal Defects, Ventricular; Hemodynamics; Humans; Infant; Kinetics; Sodium-Potassium-Exchanging ATPase

Topics: Digoxin; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant

Diagnostic separation of infants with signs of cardiac failure (hypoglycemia, sepsis, myocarditis, hypoxemia) but no congenital cardiocirculatory malformation from those with a large left to right shunt is crucial in newborn management. Echocardiographic studies of 218 infants and children allowed group separation and distinction from normal by the assessment of mean velocity of circumferential fiber shortening (Vcf) and the ratio of left atrial to aortic root diameter at end-systole (LA/Ao). In normal premature and full-term infants, Vcf (1.51 +/- 0.04 [mean +/- standard error]) was significantly lower than in infants with a large shunt (2.12 +/- 0.08, P less than 0.01) and higher than in infants with nonstructural heart disease (1.18 +/- 0.06, P less than 0.001). LA/Ao ratios were comparable in the groups with a large shunt and nonstructural heart disease (1.14 +/- 0.1 and 1.26 +/- 0.2, respectively) and were significantly higher in both groups than in normal subjects (0.77 +/- 0.01, P less than 0.001). Similar echocardiographic distinctions could be made when 10 older children (aged 2 to 10 years) with cardiomyopathy were compared with 45 normal older children. Serial determination of these variables was of major assistance in patient management.

Topics: Cardiomyopathies; Child; Child, Preschool; Diagnosis, Differential; Digoxin; Ductus Arteriosus, Patent; Echocardiography; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Myocardial Contraction; Myocarditis

Topics: Aorta; Aortic Arch Syndromes; Aortic Valve; Autopsy; Birth Weight; Chlorothiazide; Digoxin; Ductus Arteriosus, Patent; Electrocardiography; Heart Auscultation; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Male; Mitral Valve; Oxygen; Pulmonary Artery; Pulse

Topics: Anticoagulants; Blood Pressure; Cardiac Catheterization; Cardiomegaly; Dietary Fats; Digoxin; Diuretics; Heart Septal Defects, Ventricular; Heart Septum; Heart Ventricles; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Myocardial Infarction; Oxygen; Rupture; Venous Pressure

Topics: Angiocardiography; Cardiac Catheterization; Cardiomegaly; Digoxin; Electrocardiography; Extracorporeal Circulation; Female; Furosemide; Heart Auscultation; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Male; Oxygen Inhalation Therapy; Pulmonary Valve Stenosis; Pulmonary Veins; Respiratory Insufficiency

Topics: Aortic Coarctation; Aortic Valve Stenosis; Child, Preschool; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Pulmonary Valve Stenosis; Transposition of Great Vessels

Topics: Age Factors; Atrial Flutter; Digoxin; Drug Resistance; Electric Countershock; Electrocardiography; Female; Heart Failure; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intramuscular; Injections, Intravenous; Male; Pregnancy; Prognosis; Radiography; Sex Factors; Tachycardia

Topics: Angiocardiography; Bradycardia; Cardiomegaly; Digoxin; Electrocardiography; Female; Heart Block; Heart Septal Defects, Ventricular; Hepatomegaly; Humans; Hypertension, Pulmonary; Infant; Pacemaker, Artificial

In 28 infants and children with complete transposition of the great vessels, atrial septal defects were created utilizing an open technique with inflow caval occlusion and moderate hypothermia. Of the 12 infants for whom operation was necessary during the first two weeks of life only two survived, suggesting that this technique is not adequate for infants at this age. Only four of the 16 children operated on between the ages of two weeks and three years failed to survive. Two of these died because of pre-existing non-cardiac conditions. Seven children with associated systemic-to-pulmonary shunts survived; the open technique may be preferable in this particular group. Despite the initial improvement afforded by this procedure, three sudden late deaths occurred. For this reason, and because of the danger of early development of pulmonary vascular disease, total operative correction of the malformation should be performed early.

Topics: Angiocardiography; Cardiac Surgical Procedures; Child; Digoxin; Diuretics; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Septal Defects; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Hypothermia; Hypothermia, Induced; Infant; Infant, Newborn; Organomercury Compounds; Thoracic Surgery; Transposition of Great Vessels